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Maternal care should start before pregnancy and extend well beyond labor and delivery, but that often doesn’t happen.
“Countries that have far less resources than we do (in the United States) make maternal care a priority. Because we fail to do that, we are suffering the consequences of that,” said Jacquelyn McMillian-Bohler, who leads educational excellence at Duke University’s School of Nursing.
She said those consequences include preterm labors and births that can lead to unnecessary interventions and higher mortality rates.
Childbirth is far more deadly in the U.S. than in many other high-income countries such as Australia, Japan and Spain. In North Carolina and across the nation, Black women are the most at risk of dying from complications due to pregnancy.
Why that is — and what can be done to improve the odds — was the topic of Wednesday night’s EQUALibrium Live forum hosted by WFAE and the Novant Health Foundation.
“Unnecessary suffering” is how Novant obstetrician Dr. Jaleema Nanton Speaks framed this statistic from the Centers for Disease Control and Prevention: Over 80% of maternal deaths are determined by the CDC to be potentially preventable.
Black women in the U.S. are two to three times more likely to die from complications due to pregnancy. American Indian women also have a much higher maternal mortality rate.
“When we can reconcile that, I think that is what maternal health equity looks like,” Speaks said.
The maternal mortality rate for Hispanic women is slightly higher than white women, who have the lowest rate.
Obstacles to good maternal care in North Carolina
There’s a shortage of maternal health care providers in North Carolina, said Rebecca Severin, maternal health innovation program supervisor with the state’s division of public health. She said although the state is on track to expand Medicaid, nearly 10 years without it has presented challenges.
“There’s been an issue with access for some folks to get the care they need. And then you think about on top of that, 80% of North Carolina counties are considered rural,” Severin said.
Eleven rural hospitals have closed since 2005, according to UNC-Chapel Hill’s Shep’s Center for Health Services Research. Others have shut down maternity wards.
All the panelists agreed racism was a key factor in higher maternal mortality.
McMillian-Bohler said it can creep into medical training. She gave an example of a textbook she reviewed a few years ago that said a Black person may exaggerate pain.
“All of these things are taught as truisms. It’s in the textbook, therefore it must be. And then we are released out into the world to go and practice. And so you can see how this would affect not only someone who does not share the identity, but all practitioners,” McMillian-Bohler said.
Finding solutions — training, recruiting, speaking up
There are many efforts in North Carolina to improve maternal health care and to help narrow gaps. That includes setting objective standards about how to respond to issues such as sepsis or hemorrhaging, Speaks said. That’s part of the work of a network of providers called the Perinatal Quality Collaborative of North Carolina.
“So it’s not up to a provider like myself to, kind of, estimate or guesstimate if that blood pressure’s OK or acceptable, that there are objective measures and standards of care so that we apply them equally and equitably to our patients,” Speaks said.
Those efforts also include more training for nurses and doctors, recruiting more people of color into the maternal health field, and making midwives and doulas who provide information and support more accessible.
Before births moved to hospitals, McMillian-Bohler noted midwives were the standard of care.
“Having someone who was from your community, who looked like you, that shared your experience was something that was possible,” McMillian-Bohler said.
Two young Cherokee women who formed the Selu Mothering Project on the Qualla Boundary are seeing good results, said Lisa Lefler, who leads culturally-based Native Health Programs at Western Carolina University.
“They really are able to speak in a way that their young native mothers understand. They are able to address some of the other issues for the mothers, helping them receive good food for their baby,” Lefler said.
Another solution: speak up, and help family and friends understand their options when it comes to pregnancy and labor. After all, as McMillian-Bohler said, you know your body best.
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